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Mr. Owen Paterson (North Shropshire) (Con): We suffer from appalling congestion because we distribute our road assets in a manner similar to the manufacture of iron bars in Novosibirsk under the Soviet Union, so I am sympathetic to the idea. But I should like some clarification to the reply to my right hon. Friend the Member for North-West Hampshire (Sir George Young). The Secretary of State has used phrases such as new money, so if road pricing is to be brought in, can he clarify whether that money will entirely replace vehicle excise duty and fuel duty, which will be abolished?

Mr. Darling: I am grateful to the hon. Gentleman for his preparedness to look at these things. As I said to his right hon. the Member for North-West Hampshire (Sir George Young) a few moments ago, if we were moving to a new system of charging on the basis of distance travelled, varied according to how congested a road is, that would be in place of the present system. We cannot have a situation where we simply impose additional charges; it would be a radically different way of looking at these things and we need to see whether it is feasible. We need to consider whether the gains that we think would come from such a scheme are possible. If we could achieve it, there would be a huge prize. Far from having 100 million cars on Britain's roads, as his hon. Friend the Member for Lichfield (Michael Fabricant) seemed to be hinting we should, most people would rather have roads that can be driven along rather than being used as a very big car park.

Mr. Charles Walker (Broxbourne) (Con): Will the Secretary of State accept that we cannot preserve our roads only for rich people? In my constituency, there is genuine concern about some of the figures that have been talked about in the press—for example, £1.34 a mile, which would mean that a nurse commuting from
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Broxbourne to Chase Farm paid about £120 a week in charges. We could give her all the free petrol she could use and it still would not cover the £120 charge.

Mr. Darling: I am sure that the hon. Gentleman will have pointed out to his constituent that the study from which the figure of £1.34 was derived stated that the charges would range from 2p a mile to £1.34, and the   £1.34 would be paid by only 0.5 per cent. of the population, on a very narrow range of streets, at very busy times. We have to be grown up about these things, but inevitably, given a range of figures, people reporting these matters tend to go for the highest rather than the lowest. I have no doubt that the hon. Gentleman will want to tell his constituent that, and if he likes, I will happily write him a letter making that point, which he can pass on.

Mr. Andrew Turner (Isle of Wight) (Con): May I say gently to the Secretary of State that we do not all live on one island, overcrowded or otherwise? People who travel to and from my constituency are among the few who already pay charges, which vary, depending on congestion and distance, and considerably exceed £1.34 a mile. My constituents pay road fund licence fees and petrol duty in addition. The Secretary of State has a rural bus grant and the Chancellor has announced half-price bus fares for pensioners, so will the Secretary of State tell us whether the transport innovation fund can be used to extend those benefits to passenger ferry users?

Mr. Darling: I have to disappoint the hon. Gentleman. The transport innovation fund is not intended to fund concessionary travel of the sort to which I think he refers. I know that he had hoped to be in the Chamber at Transport questions to raise that point last time, but unfortunately he could not—I do not know whether the ferry held him up. Concessionary travel might be part of an overall strategy, but the hon. Gentleman asked specifically whether the fund could be used to support such travel—like the £350 million that the Chancellor has allocated for concessionary travel for pensioners—and the answer is, no, that is not what it is intended to do.

I am well aware of the fact that not everyone in the UK lives on one island. I do not live on an island, but I know an island well and it is expensive to cross the sea to go there, so I understand that point perfectly. The hon.    Gentleman will know that under successive Governments ferry fares are not always based on what it would cost to drive along a road—but there are other benefits to living on an island, as I am sure he knows.

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Pharmaceutical Labelling (Warning of Cognitive Function Impairment)

4.14 pm

Mr. Andrew Dismore (Hendon) (Lab): I beg to move,

This is the second time for this Bill—I secured a ten-minute rule motion in the last Session, but the general election meant that the Bill fell, as the scheduled Second Reading date was after the election. Since then I have continued to consult on the proposal with national organisations, as well as locally with pharmacists in my   constituency, directly and through the Barnet Pharmaceutical Committee, which is very supportive of the Bill, as is my local primary care trust. I have also held a consultation with local residents, and the responses that I have received are overwhelmingly in favour.

Turning to the substance of the Bill, a psychoactive pharmaceutical is one that has a direct action on the brain and thus exerts its clinical effects, such as reducing depressive symptoms or levels of anxiety, or inducing a good night's sleep. Such pharmaceuticals are also used to treat panic attacks, post traumatic stress, obsessive-compulsive disorders and allergies. The direct action on the brain needed to alleviate the symptoms also gives the potential to affect other nervous functions for the accurate performance of the tasks of daily living, whether at home, on the roads or in the workplace, including the rate of information processing, alertness and attention, visual processes, motor co-ordination and memory. I would hazard a guess that most of us in the House today know someone who has used these perfectly legal drugs without knowing that if the user were then to take to the roads their judgment could be just as impaired as if they had drunk alcohol well over the legal limit.

Over a five-month period, Professor Hindmarch of Surrey university conducted a pilot study in which blood samples were collected from people at two hospitals treating accidental injuries. The results of the study implied strongly that the presence of tricyclic antidepressants and benzodiazepines presented an increased risk of accidental injury. Under a different pilot scheme, information on contributory factors to road accidents was collected by 15 police forces in 2002 and 2003. The influence of drugs was recorded as a contributory factor proportionally on a par with the effect of excess alcohol, although it is not clear what proportion were legal or illegal drugs.

In 2001, the Transport Research Laboratory published a study to measure the incidence of drugs in fatal road accident casualties. An earlier study published in 1989 had found that the incidence of medicinal drugs, at 5.5 per cent., and illegal drugs, at 3 per cent., was relatively low in comparison with alcohol at 35 per cent. However, the 2001 study, based on results collected between 1996 and 2000, found that the incidence of medicinal and illegal drugs in the blood samples of road traffic fatalities was three times higher than in the previous study, at 24 per cent., while the incidence of alcohol had fallen to 31 per cent.—again, figures roughly in parallel.
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A Canadian study of fatal road accidents in 1981 found that drivers who had used benzodiazepines were found culpable in 98 per cent. of the cases examined. Drivers involved in fatal road accidents who were taking antihistamines were found culpable in 72 per cent. of cases.

There is no defined limit for drug use as there is for alcohol, and no such clear-cut test as the random breath test. Moreover, the law does not make a distinction between illegal or misused drugs and "over-the-counter" or prescription drugs, taken as directed by a GP or other medical practitioner. Just as we have come round to welcoming a culture that emphasises the need for warnings about alcohol levels—driving while drunk is no longer tolerated, and for most employers drunkenness at work is a dismissible offence—it is time to ensure that those using psychoactive drugs are aware of their effect.

The Driver and Vehicle Licensing Agency provides advice to medical professionals, and doctors and pharmacists should provide information when dispensing prescriptions or other medicines. The Department for Transport is also currently researching the attitudes of UK health professionals about providing "fitness-to-drive" advice to the public. This includes an examination of advice given in relation to medication. However, this is not enough. Clearer labelling seems to me an excellent way both to alert the public to the unexpected hazards of what they may be taking to cure their ills, and to provide a clear safety message, triggering the need to consider the risks before driving or embarking on potentially hazardous work. Who would be willing to wield a dangerous power tool if they knew that their reactions might be seriously impaired?

At the moment, there may be a pharmacy sticker stating, "Do not drive if you feel drowsy," or, "may cause drowsiness". But of course by that time it is already too late, as the safe limits will have been exceeded. Inside the package, there may be a tightly folded patient information leaflet. If people manage to unwrap it, they find the print so small and illegible that they need a magnifying glass to read it. Of course, for those of our fellow citizens or visitors to our shores who speak little or no English, the leaflet is of little use or no use at all—and as the language used is very rarely plain English, it is often not much help to the rest of us either.

I do not believe that such warnings are adequate. The labelling is ambiguous and unhelpful. The patient is extremely unlikely to have insight into the actual level of drowsiness that is being caused in the brain. At present, those unclear or inadequate warnings could also leave the drug manufacturer, the prescribing doctor or the dispensing pharmacist at risk of a civil action for compensation for negligence if the patient suffers injury as a direct result of taking the medicine, without fully appreciating the risks, as a consequence of such a poor warning. The pharmacist who adopts present good practice by verbally supplementing the warning may well not escape liability, as things stand. The proposals in my Bill would significantly reduce, and probably eliminate, that risk of civil liability.
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My Bill would require the external packaging of those medicines known to have an effect on judgment to be prominently marked. I propose the use of a red triangle, meaning quite simply, "the use of this medication could seriously impair your judgment," although the Bill leaves the precise design of the warning to be decided after appropriate consideration and consultation. The main classes of medication, although there are others, that would fall into the red triangle category would be benzodiazepines, which are available only on prescription and used primarily for anxiety or sleep disturbance; tricyclic antidepressants, which are also available only on prescription; and antihistamines, which are available over the counter to treat common complaints such as hay fever and conjunctivitis.

A report compiled by Loughborough sleep research centre identified those medicines that are available over the counter with the potential to cause drowsiness and, therefore, the potential to be hazardous. From the literature, it is clear that one antihistamine group—the H1 receptor—is particularly sedative and is even used for the relief of temporary sleep disturbance in some circumstances. The impairment caused by the recommended doses of at least two of those drugs is greater than that caused by the legal blood alcohol concentration limit for driving in this country. The elderly are particularly vulnerable to the sedative effects of those drugs.

I do not suggest that those drugs are dangerous in themselves or that their use should be curtailed in either prescription or over-the-counter sales; rather, what I advocate is that, because those drugs will continue to be used regularly by huge numbers of the population, a red triangle marking would stand as an unambiguous warning that the ability to drive or work safely might well be impaired on taking the drug. That would give users more control over their activities and an option to seek different medication if appropriate. Choice and control in avoiding preventable accidents are of paramount importance.

This view has already been taken in other countries. In Canada, a warning symbol was introduced under the Controlled Drugs and Substances Act 1996. In other countries such as France, the Netherlands and Denmark, a clear system of symbols is used: green if it is safe to drive; amber if caution is needed; and red to show that people must not drive. The European Commission has acknowledged the benefits of such a system and referred to the need for the appropriate labelling of medicines in the European road safety action programme for 2003 to 2010, which aims to halve the number of people killed on the roads by 2010.

EU directive 2001/83, dated 6 November 2001, deals with the Community code that relates to medicinal products for human use. Article 62 states that warning symbols may be used on the packaging of medicines to provide a clear warning of possible adverse effect. It states:

the detailed technical information and a summary of the product characteristics, which are useful for health education and are set out on the packaging and patient information leaflet.
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Red triangle symbols are currently in use in Denmark, France, Iceland and Norway, and other versions of similar symbols are used in Austria, Belgium, Italy and Spain. The UK is lagging behind continental Europe. We should move towards a visible warning on those medicines that will leave no adult in any doubt about their potential effects. The red triangle is an obvious, visible warning saying, "Be careful what tasks you choose to do. Do not drive. Do not operate machinery." We need to act now to cut deaths and injuries on the road, in the workplace and at home. I hope my Bill will find favour with the House today.

Question put and agreed to.

Bill ordered to be brought in by Mr. Andrew Dismore, Stephen Pound, Martin Salter, Mr. David Hamilton, Dr. Alan Whitehead, Angela Eagle, Miss Anne Begg, Ann Keen, Mr. Neil Gerrard, Mr. Andrew Slaughter and Paul Flynn.

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